Health Bihaviors to Prevent Cardiovascular Risk: A Systematic Review of the Literature

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In addition, the management of cardiovascular diseases is hampered by poor access to quality healthcare hence the importance of primary prevention. The aim of this literature review was to identify good health behaviors to be adopted by individuals to prevent the onset of cardiovascular disease. Results A total of 25 review articles were selected from Google scholar, Science Direct, PubMed and American heart association journals. The screening and an effective treatment of dyslipidemia, hypertension, diabetes mellitus and obesity are essential means of preventing cardiovascular diseases. The lifestyle behaviors identified and their associated reduction of cardiovascular risk are respectively, not smoking (36 to 71%); a healthy diet (11 to 59%) consisting of regular consumption of fruit and vegetables, wholegrain cereals, polyunsaturated fatty acids and nuts, and chicken or fish rather than red meat; reducing alcohol consumption to one glass a day (10 to 23%) ,regular moderate to intense physical activity lasting at least 2.5 hours a week( 10 to 28%), reducing of salt consumption (23%) while sleep duration of ≤5heures and ≥9 hours can double cardiovascular risk . When combined, these behavioral protective factors potentiate each other and cardiovascular risk reduction can reach 70-90%. Conclusion The adoption of health-care behaviors (screening, early treatment) and a healthy lifestyle (diet, physical activity) reduces the risk of cardiovascular disease. Preventive Medicine Health behaviors to prevent cardiovascular risq systematic review Figures Figure 1 I. Introduction Cardiovascular disease is a group of disorders affecting the heart and blood vessels, including coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart defects, deep vein thrombosis and pulmonary embolism ( 1 ). An estimated 17.9 million people died from cardiovascular disease in 2019, accounting for 32% of all deaths worldwide. Of these deaths, 85% were due to myocardial infarction or stroke. More than three-quarters of deaths attributable to cardiovascular disease occur in low- and middle-income countries ( 2 ). In these countries, the fight against cardiovascular disease must focus on prevention, as there are insufficient resources to treat it ( 3 ). In addition, low levels of health literacy contribute to the high prevalence of cardiovascular disease in Africa ( 4 ). Several scientific studies have been devoted to identify the risk factors for the onset of cardiovascular disease. This review looks at the main modifiable risk factors for cardiovascular disease, especially in adults, and how these can guide prevention. II. Methods This systematic review was conducted in accordance with the principles of PRISMA (preferred reporting items for systematic review and meta-analyses) guidelines. The stages of the literature review and the number of references selected are illustrated in Fig. 1 . Article selection Published articles were identified and selected from the following scientific bibliographic databases: Google scholar, PubMed, Science Direct, American Heart Association. The search was carried out by subject using the following queries: cardiovascular risk factors AND prospective study, Lifestyle risk factor AND cardiovascular disease, sodium intake AND cardiovascular disease, alcohol AND cardiovascular disease. Inclusion criteria The main selection criteria were published research articles, the relevance and validity of the study, an analytical epidemiological study such as a cohort or case-control study, study participants aged 18 years or older, the strength of the association expressed as a relative risk, hazard ratio or odd ratio with its confidence interval, studies published in English or French, the study population free of cardiovascular disease at inclusion Exclusion criteria The exclusion criteria were the presence of cardiovascular disease at inclusion and articles written in languages other than French or English Data extraction The following information was extracted: name of the study, first author, sample size, type of study, risk factors involved, duration of the study, age and sex of participants, main results in relation to the study objective. The study quality was assessed by the large number of participants, the expression of risk ratios by confidence intervals, the rigorous description of the study, a long duration of the study and the absence of cardiovascular disease at baseline. Data synthesis and analysis The main characteristics of the selected studies are summarized in Table 1. For each metabolic or lifestyle cardiovascular risk factor, the following elements were presented: the first author of the study, the bibliographic reference number, the risk ratios surrounded by its significant confident intervals. The reduction of cardiovascular risk was deduced for protective factor using this formula (1-RR/OR/HR) *100%; RR expressing relative risk, OR expressing odds ratio, HR expressing the hazard ratio. III. Results In this review of the literature, 25 articles meeting the inclusion criteria were selected, 3 articles concerned studies extended to the African continent (Swamithan and al ( 5 ), Scheen and al ( 6 ), O'Donnel and al ( 7 )). The average follow-up time of the cohort studies was 11 years. This systematic review of the literature describes the role of modifiable cardiovascular risk factors based on scientific evidence and deduces the healthy behaviors to adopt in order to reduce cardiovascular risk. Table I: Characteristics of selected studies References, year of publication design of the study, country(ies) Duration of follow-up Number, Sex, age of participants Tian and al( 8 ), 2023 Cohort study, United Kingdom 12 years ≥ 40 years,226759,male and female, Couillard and al( 9 ),1998 cohort study, Canada 5 years 47–76 years,2151, male, Nguyen and al( 10 ), 1997 cohort study, USA 14 years 24–61 years,11553,male, female, 14 years Peters and al( 11 ), 2014 Cohort study, Australie, Nouvelle zélande, China, Hong Kong, Japan, South Corea, Singapoure, Taiwan, Thailand 6 years 35–75 years,996624,male, female,6 years Jousilhati and al( 12 ),1999 Cohort study, Finlande 7 years 25–64 years,14786,male, female, Bostom and al( 13 ),1994 Cohort study, USA 7 years 35–64 years,3103,female Chomistek and al( 14 ),2015 Cohort study, USA 20 years 27–44 ans,88940,women Lv and al( 15 ),2014 Cohort study, Chine 7,2 years 30–79 years,461211,female,male Chiuve and al( 16 ),2006 Cohort study, USA 16 years 40-75years,42847,male Larsson and al( 17 ),2014 Cohort study, Suède 13 years 45–83 years,64676,male, female Scheen and al( 6 ) 2004 Case control study, Asie, Europe, Moyen Orient, Afrique, Australie, Amérique du Nord, Amérique du Sud Male, female,15152 case,14820 control O'Donnel and al( 7 ) 2010 Case control study, Africa, Asia, Europe, Australie, America Male,female,3000 case,3000 contrôle Swamithan and al( 5 ), 2021 Prospective study, America, Africa, Middle East, South Asia, China 9.5 years 148858,35–70 years, male, female Steffen and al( 18 ),2003 Prospective study, USA 11 years 157792,male,female,45–64 years Tao and al( 19 ),2021 Cohort study, UK 8.57 years 407500,38–73 years, male, female Wilson and al( 20 ),2005 cohort study, USA 8 years 3310,male,female,moyenne 57,59 years Cohen and al( 21 ) Nested Case control study, UK 25663,male,female,45–79 years Debras and al( 22 ),2022 Cohort study, France 9 years 103388,male,female,≥18 years Sun and al( 23 ), 2024 Cohort study, UK 12 years 107227,male,female,35–73 years Zhang and al( 24 ),2021 Cohort study, Chine 10 years 87723,masculin, féminin,≥18years Liu and al( 25 ),2018 Cohort study, Chine 18 years 945,masculin,féminin,35-59years Ma Hao and al( 26 ),2022 Cohort study, UK 11.8years 176570,masculin,féminin,37–73 years Ma Yuan and al( 27 ),2022 Cohort study, USA 8.8 years 10707,masculin,féminin,51 ± 12,6 years Ayas and al( 28 ),2003 Cohort study, USA 10 years 71617,feminin,45–65 years Sabanayagam and al( 29 ),2012 Case control study, USA 31428,female,male,≥ 18 &ns 1. Metabolic factors Modifiable risk factors are factors which can be reduced or eliminated by human action. They are classified into two subgroups: metabolic factors, or factors relating to a physiopathological state, and lifestyle factors, or behavioral factors [9]. The role of metabolic risk factors has been highlighted by several scientific studies; some of them have been included in this literature review to illustrate their causality in the occurrence of cardiovascular disease. These risk factors are arterial hypertension, dyslipidemia, diabetes mellitus and overweight. Hypertension is defined as systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg recorded at two distinct occasions and not on the same day. Dyslipidemia is a metabolic abnormality characterized by an abnormal concentration of lipids in the blood, such as total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides ( 28 ). Total cholesterol should be less than 2.2 g/L, LDL cholesterol less than or equal to 1.6 g/L and HDL cholesterol greater than 0.4 g/L. Normal triglyceride levels are between 1.5 and 2 g/L. Diabetes mellitus is a metabolic disease characterized by the presence of chronic hyperglycemia resulting either from a deficiency in insulin secretion, an abnormality in insulin action on target tissues, or a combination of both. Diabetes mellitus takes three forms: Type 1 diabetes, which is autoimmune in origin, type 2 diabetes, in which insulin resistance plays an important role, and gestational diabetes ( 30 ). Obesity is a complex, chronic disease defined by excessive deposition of adipose tissue, which can be detrimental to health. Overweight and obesity are diagnosed by measuring weight and height, and calculating the body mass index (BMI): weight (kg)/height² (m²). According to World Health Organization criteria, an individual is said to be overweight when his or her BMI is between 25 KG/m2 and 29.9 kg/m2, and obese when his or her BMI is ≥ 30 kg/m2 ( 31 ). Table II illustrates the causal role of metabolic risk factors in the development of cardiovascular disease. Table II: Causality of metabolic cardiovascular risk factors Risk factors Studies Adjusted risk ratio High blood pressure Couillard and al( 9 ) 2.32(1.35–3.94) Peter and al( 11 ) 1.38(1.25–1.51)♀ 1.38(1.28–1.46)♂ Jousilahti and al( 12 ) 1.11(1.07–1.16)♀ 1.11(1.04–1.18)♂ Wilson and al( 20 ) 1.15(1.09–1.20 Cohen and al( 21 ) 1.56(1.22–1.99) Hypercholesterolemia Couillard and al( 9 ) 2.15(1.34–3.44) Bostom and al( 13 ) 2.26(1.41–3.62 Nguyen and al( 10 ) 1.32(1.2–1.5)♀ 1.4(1.2–1.7)♂ Peter and al( 11 ) 1.25(1.16–1.35) ♀ 1,35(1.26–1.44) ♂ Hypertryglycéridemia Peter and al( 11 ) 1.33(1.16–1.54) ♀ 1.24(1.16–1.32) ♂ Nguyen and al( 10 ) 1.4(1.12–1.6) HyperLDLémia Tian and al( 8 ) 1.06(1.02–1.09) Couillard and al( 9 ) 2.28(1.38–3.75) Cohen and al( 21 ) 1.68(1.33–2.14) HyperHDLémia Couillard and al( 9 ) 0.50(0.30–0.81) Jousilahti and al( 12 ) 0.50(0.39–0.64♀ 0.45(0.38–0.54)♂ Cohen and al( 21 ) 0.57(0.44–0.73) Diabetes mellitus Tian and al( 8 ) 1.52(1.44–1.61) Wilson and al( 20 ) 2(1.56–2.55) Peter and al( 11 ) 2.04(1.58–2.64)♀ 1.56(1.32–1.90)♂ Overweight or obesity Peter and al( 11 ) 1.22(1.09–1.37)♀ 1.25(1.15–1.36)♂ Cohen and al( 21 ) 1.74(1.36–2.23) Tian and al( 8 ) 1.25(1.21–1.30) To prevent the onset of cardiovascular disease, it is essential to combat metabolic cardiovascular risk factors by reinforcing health education so that adults could adopt positive health behaviors. Firstly, screening for potential health problems such as dyslipidemia, diabete mellitus, obesity and high blood pressure and once these conditions have been identified, follow medical or dietary-hygienic treatment. 2.Behavioral factors Behavioral risk factors can be modified by the individual according to the lifestyle he or she adopts. Research into etiological epidemiology has highlighted behavioral risk factors, and we present some of the scientific evidence to support the development of health-promoting lifestyles. Smoking Smoking refers to tobacco consumption or intoxication related to tobacco use. Tian and al( 8 ) have demonstrated the role of smoking in the onset of cardiovascular disease: adjusted RR = 1.16 (1.13–1.20); and other authors have reached similar conclusions concerning smoking, including Couillard and al( 9 ) adjusted RR = 1.20(1.05–1.35) ; Peter and al( 11 ) Adjusted RR = 1.61(1.39–1.87) ♀ Adjusted RR = 1.52(1.39–1.68) ♂ ; Jousilahti and al( 12 ) Adjusted RR = 1.77(1.49–2.11) ♀ Adjusted RR = 2.14(1.46–3.14) ♂ ; Scheen and al ( 6 )adjusted OR = 2.87(2.58–3.19); O'Donnel and al ( 7 )adjusted OR = 2.09(1.75–2.51). No smoking has been identified as a protective factor by Chomistek and al ( 14 ) RR adjusted = 0.29(0.23–0.35); Larsson and al ( 17 ) RR adjusted = 0.64(0.50–0.84); Chiuve and al ( 16 ) RR adjusted = 0.47(0.41–0.53) ♀ RR adjusted = 0.57(0.46–0.69) ♂. The reduction of cardiovascular risk varies from 36% to 71% for non-smokers compared to smokers. Diet High consumption of vegetables and fruit, wholegrain cereals, nuts, legumes, polyunsaturated fatty acids, moderate alcohol consumption combined with low consumption of sugar, sweetened beverages, red meat or processed meat was identified as a protective factor by Chomistek et al ( 14 ) RR adjusted = 0.69(0.57–0.85). Consumption of polyunsaturated fatty acids to the detriment of trans fatty acids, consumption of chicken meat and fish to the detriment of red meat, high consumption of vegetables and fruit, soy products, cereal fibers, and tofu was identified as a protective factor Adjusted RR = 0.75(0.69-0, 82) by Chiuve et al ( 16 ) Regular consumption of fruit and vegetables, nuts, skimmed milk products, wholegrain cereals and fish to the detriment of red or processed meat, fried potatoes, solid fats, refined cereals, various sweet foods and full-fat cheese was isolated as a protective factor by Larsson et al ( 17 ) Adjusted RR = 0.76(0.65–0.90) Daily consumption of fruit and vegetables and limited consumption of red meat is a protective factor highlighted by Lv et al ( 15 ) Adjusted RR = 0.89(0.84-à.94). The reduction of cardiovascular risk varies from 11% to 59% among people who adopt an adequate diet compared to those with non-adequate diet. A diet rich in fruit and vegetables as a daily intake was identified as a protective factor by Scheen and al ( 6 ) Adjusted OR = 0.70(0. 62-0.79) and O’Donnel and al ( 7 ) Adjusted OR = 0.61(0.50-0,73). Consumption of artificial sweeteners was identified as a cardiovascular risk factor by Sun and al ( 23 ) adjusted RR = 1.012(1.008–1.017) and Debras and al ( 22 ) adjusted RR = 1.09(1.01–1.18). Sweeteners are food additives that impart a sweet taste without increasing the sugar content. Swamithan and al ( 5 ) identified high consumption of refined cereals as a cardiovascular risk factor (adjusted RR = 1.33(1.16–1.52)) while Steffen and al ( 18 ) highlighted the protective role of whole-grain consumption (adjusted RR = 0.72(0.53–0.97)) and high fruit and vegetable consumption (adjusted RR = 0.59(0.42–0.81)). In summary, based on the above, the foods recommended for good cardiovascular health are listed in Table 3 Table III: List of recommended and non-recommended foods for cardiovascular prevention Recommended food Non-recommended food 1.Vegetables 2.Fruit 3.Chicken 4.Fish 5.Nuts 6.Wholegrain cereals: whole meal flours, brown bread 7.Skimmed milk products 8.Polyunsaturated fatty acids: olive oil, corn oil, sunflower oil, sesame oil, peanut oil, oily fish, sardines, walnut oil, etc. 9.Soy products 1.Red meat 2.Refined cereals: white flour, white bread 3.Saturated fatty acids of animal origin: cold meats, butter 4.Trans fatty acids: fried foods, bakery products, cookies, pie, dairy products 5.Sugary drinks 6.Sweeteners: soft drinks, canderel Salt consumption High excretion of sodium in urine was identified as a cardiovascular risk factor by Liu and al ( 25 ) adjusted RR = 3.04(1.46–6.34) and by Ma Yuan and al ( 27 ) adjusted RR = 1.18(1.08–1.29). The permanent addition of table salt was isolated as a cardiovascular risk factor by Ma Hao and al ( 26 ) Adjusted RR = 0.77(0.70–0.84). The reduction of cardiovascular risk can be estimated to 23% among people who reduce salt consumption. To reduce salt consumption, good habits are suggested: consume home-cooked meals, eat mainly fresh and minimally processed foods, choose low-sodium products (less than 120 mg/100 g sodium), cook adding little salt, use herbs or spices to flavor foods, rather than salt, limit the use of salad dressings, remove the salt shaker from the table (32). Consumption of alcohol Table IV: Quantity, frequency of alcohol consumption and associated cardiovascular risk Authors Quantity of alcohol consumed ajusted RR Chomistek and al( 14 ) O.1-14.9g/day i.e. one glass 0.77(0.64–0.93) Chiuve and al( 16 ) 5–30 g/day i.e moderate 0.77(0.70–0.84) Lv and al( 15 ) 150 g/week versus light to moderate consumption 30 glasses per month 1.51(1.18–1.91) The reduction of cardiovascular risk varies from 10% to 23% among people who drink a moderate quantity of alcohol compared to heavy drunker. Light to moderate alcohol consumption should be encouraged to prevent cardiovascular disease. Physical activity Table V: Frequency and duration of physical activity and associated cardiovascular risk Authors Frequency and duration RR Chomistek and al( 14 ) 2.5 hours a week of moderate to intense physical activity 0.72(0.58–0.88) Chiuve and al ( 16 ) 30 minutes a day of moderate or intense physical activity or more than or equal to 3.5 hours a week 0.72(0.65–0.80) Lv and al( 15 ) Median of recommended levels 0.90(0.87–0.93) Scheen and al( 6 ) At least 4 hours a week 0.86(0.76–0.97) The reduction of cardiovascular risk varies from 10% to 28% among adult who practice moderate to intense physical activity. Regular moderate to intense physical activity lasting at least 2.5 to 4 hours a week is recommended to prevent cardiovascular disease. Sleep Quality sleep (without insomnia or narcolepsy) and optimal sleep duration (7 hours a day) have been identified as protective factors against the onset of cardiovascular disease. Thus, individuals with disturbed sleep have a higher risk of cardiovascular disease than individuals with healthy sleep (Tian and al ( 8 ) adjusted RR = 1.06(1.02–1.09) ;( Tao and al ( 19 ) adjusted RR = 1.26(1.21–1.32). Individuals with a sleep duration greater than or equal to 9 hours per day or less than or equal to 5 hours per day have a great risk of developing cardiovascular disease than those who sleep 7 hours a day (Tao and al ( 19 ) Adjusted RR = 1.23(1.16–1.31)) ; (Ayas and al ( 28 ) Adjusted RR = 1.82(1.34 ;2.41), Adjusted RR = 1.57(1.18 ;2.11)); (Sabayagam and al ( 29 ) Adjusted RR = 2.20(1.73 ;2.71) Adjusted RR = 1.57(1.31 ;1.89)). Good sleep habits, such as going to bed and getting up at a fixed time, and sleeping 7 hours a day, are among the factors contributing to good cardiovascular health. Mental health Depression has been identified as a cardiovascular risk factor by Tian and al ( 8 ) adjusted RR = 1.35(1.25–1.45), Scheen and al ( 6 ) adjusted OR = 1.55(1.42–1.69); O'Donnell and al ( 7 ) adjusted OR = 1.35(1.10–1.66). Psychosocial stress has also been identified as a cardiovascular risk factor by Scheen and al ( 6 ) adjusted OR = 2.67(2.21–3.22) and O'Donnell and al ( 7 ) adjusted OR = 1.30(1.06–1.60). Maintaining and restoring mental health contributes to good cardiovascular health Combination of several behavioral factors Chomistek and al ( 14 ) (adjusted RR = 0.08(0.03–0.22), Chiuve and al ( 16 ) (adjusted RR = 0.37(0.26–0.53), Lv and al ( 15 ) (adjusted RR = 0.37(0.16–0.84), Larsson and al ( 17 ) adjusted RR = 0, 14(0.04–0.43) have demonstrated through their cohort studies that several good health habits in the same individual increase their protective effects against the onset of cardiovascular disease. The reduction of cardiovascular risk varies from 70% to 90%. Thus, an individual should at best practice several health habits to maintain his or her cardiovascular health. Table VI: Behavioral risk factors and their combined effects Table VII: Summary of health-promoting habits to prevent cardiovascular disease in adult men and women 1 Screening for diabetes, high blood pressure, dyslipidemia or obesity 2 Follow treatment for diabetes, high blood pressure, dyslipidemia 3 Avoid smoking or give up smoking 5 Prefer recommended foods or at best avoid non-recommended foods 6 Reduce salt intake, avoid adding salt in meals 7 Reduce alcohol consumption at one glass a day 8 Practice regular physical activity for at least 2.5 hours a week 9 Sleep and get up at set times, get at least 7 hours of sleep 10 Make time for relaxation 11 Try to combine as many of the above behaviors as possible to improve cardiovascular health. IV. Discussion The aim of this literature review was to identify good health habits that can be adopted to prevent the onset of cardiovascular disease, whether deducted from metabolic factors or lifestyle factors. A selection of articles relevant to the subject was made to include 25 analytical studies, 21 of them were conducted according to the prospective cohort design. Only 3 studies were extended to the African continent. Screening or controlling metabolic risk factors is one of the health habits to be adopted to prevent the onset of cardiovascular disease. Adults should undergo regular health checkups to detect any metabolic risk factors. Other authors such as Andréadis et al ( 33 ) and Jeppesen et al ( 34 ) have identified metabolic syndrome as a factor increasing cardiovascular risk. The metabolic syndrome is defined by an accumulation of abdominal fat in addition to two of the following abnormalities: hyperglycemia, hypertriglyceridemia, hypoHDLemia and arterial hypertension. Lifestyle-related cardiovascular risk factors are also a prime target for cardiovascular prevention. Although some studies show benefits of moderate alcohol, recent research warns about cancer risk ( 35 , 36 , 37 , 38 ). So, avoiding alcohol may be safest overall. Lifestyle factors, when combined, have a powerful synergistic effect. This idea is supported by other authors, notably Zhang et al ( 39 ) in their systematic review and meta-analysis of prospective cohorts. The adoption of identified health behaviors faces economic constraints. Indeed, non-communicable diseases such as hypertension, diabetes mellitus and dyslipidemia require treatment and prolonged follow-up, which are not financially accessible to a large number of individuals in low-income countries. Similarly, daily access to fruit and vegetables in addition to calorie-dense foods, and access to chicken or fish meat, is not automatic due to financial constraints. On the other hand, certain behaviors are accessible, such as avoiding tobacco and alcohol, regular physical activity, quality sleep, reduced salt consumption, and consumption of polyunsaturated fatty acids rather than saturated oils. Although this systematic review identified healthy behaviors that adults should adopt to reduce cardiovascular risk, the study faced limitations such as the scarcity of prospective studies in Africa hence the inclusion of case-control studies even though they have a low level of scientific evidence compared to prospective studies. As perspectives, prospective studies should be encouraged in Africa VI. Conclusion In conclusion, the health behaviors to prevent cardiovascular risk should be encouraged to adults, whether during health education sessions or community awareness campaigns. Regarding alcohol consumption, rather than light to moderate consumption, abstinence from alcohol is the best way to prevent non-communicable diseases in general. Declarations Data availability Not applicable Ethics declaration Not applicable Competing interests The authors declare that they have no competing interests. Funding Not applicable Authors’ contribution Author N M provided the idea of working on health behaviors to reduce cardiovascular risk, wrote the text and tables. L B S provided the overall idea of doing a systematic review on cardiovascular risk factors, the idea of illustrating cardiovascular risk reduction and improvements to the presentation of the text. N T provided guidance to better present the ideas. 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JAMA Netw Open 5(8):E2228544. 10.1001/jamanetworkopen.2022.28544 Zhang YB, Pan XF, Chen J, Cao A, Xia L, Zhang Y, Wang J, Li H, Liu G, Pan A (2021) Combined lifestyle factors, all-cause mortality and cardiovascular disease: A systematic review and meta-analysis of prospective cohort studies. J Epidemiol Commun Health 75(1):92–99. https://doi.org/10.1136/jech-2020-214050 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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12:03:44","extension":"html","order_by":56,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159622,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7846964/v1/c850afa6d20c195022571bc1.html"},{"id":93491102,"identity":"6aa8b92c-6309-4bc9-a647-18af2ad3c2eb","added_by":"auto","created_at":"2025-10-14 12:11:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":67519,"visible":true,"origin":"","legend":"\u003cp\u003eLiterature search and analysis strategy\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7846964/v1/29d82eee3375f1832540baba.png"},{"id":93492861,"identity":"dcb852ba-1012-4131-9e3f-71bea5626743","added_by":"auto","created_at":"2025-10-14 12:35:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1116370,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7846964/v1/95bc7d1f-8554-458b-b81f-5ae9670f6210.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eHealth Bihaviors to Prevent Cardiovascular Risk: A Systematic Review of the Literature\u003c/p\u003e","fulltext":[{"header":"I. Introduction","content":"\u003cp\u003eCardiovascular disease is a group of disorders affecting the heart and blood vessels, including coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart defects, deep vein thrombosis and pulmonary embolism (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). An estimated 17.9\u0026nbsp;million people died from cardiovascular disease in 2019, accounting for 32% of all deaths worldwide. Of these deaths, 85% were due to myocardial infarction or stroke.\u003c/p\u003e\u003cp\u003eMore than three-quarters of deaths attributable to cardiovascular disease occur in low- and middle-income countries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In these countries, the fight against cardiovascular disease must focus on prevention, as there are insufficient resources to treat it (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In addition, low levels of health literacy contribute to the high prevalence of cardiovascular disease in Africa (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral scientific studies have been devoted to identify the risk factors for the onset of cardiovascular disease. This review looks at the main modifiable risk factors for cardiovascular disease, especially in adults, and how these can guide prevention.\u003c/p\u003e"},{"header":"II. Methods","content":"\u003cp\u003eThis systematic review was conducted in accordance with the principles of PRISMA (preferred reporting items for systematic review and meta-analyses) guidelines. The stages of the literature review and the number of references selected are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eArticle selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePublished articles were identified and selected from the following scientific bibliographic databases: Google scholar, PubMed, Science Direct, American Heart Association. The search was carried out by subject using the following queries: cardiovascular risk factors AND prospective study, Lifestyle risk factor AND cardiovascular disease, sodium intake AND cardiovascular disease, alcohol AND cardiovascular disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe main selection criteria were published research articles, the relevance and validity of the study, an analytical epidemiological study such as a cohort or case-control study, study participants aged 18 years or older, the strength of the association expressed as a relative risk, hazard ratio or odd ratio with its confidence interval, studies published in English or French, the study population free of cardiovascular disease at inclusion\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe exclusion criteria were the presence of cardiovascular disease at inclusion and articles written in languages other than French or English\u003c/p\u003e\u003cp\u003e\u003cb\u003eData extraction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe following information was extracted: name of the study, first author, sample size, type of study, risk factors involved, duration of the study, age and sex of participants, main results in relation to the study objective.\u003c/p\u003e\u003cp\u003eThe study quality was assessed by the large number of participants, the expression of risk ratios by confidence intervals, the rigorous description of the study, a long duration of the study and the absence of cardiovascular disease at baseline.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData synthesis and analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe main characteristics of the selected studies are summarized in Table\u0026nbsp;1. For each metabolic or lifestyle cardiovascular risk factor, the following elements were presented: the first author of the study, the bibliographic reference number, the risk ratios surrounded by its significant confident intervals.\u003c/p\u003e\u003cp\u003eThe reduction of cardiovascular risk was deduced for protective factor using this formula (1-RR/OR/HR) *100%; RR expressing relative risk, OR expressing odds ratio, HR expressing the hazard ratio.\u003c/p\u003e"},{"header":"III. Results","content":"\u003cp\u003eIn this review of the literature, 25 articles meeting the inclusion criteria were selected, 3 articles concerned studies extended to the African continent (Swamithan and al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), Scheen and al (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), O'Donnel and al (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)). The average follow-up time of the cohort studies was 11 years. This systematic review of the literature describes the role of modifiable cardiovascular risk factors based on scientific evidence and deduces the healthy behaviors to adopt in order to reduce cardiovascular risk.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable I: Characteristics of selected studies\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReferences, year of publication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003edesign of the study, country(ies)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDuration of follow-up\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNumber, Sex, age of participants\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTian and al(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), 2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, United Kingdom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;40 years,226759,male and female,\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCouillard and al(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e),1998\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecohort study, Canada\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47\u0026ndash;76 years,2151, male,\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNguyen and al(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), 1997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u0026ndash;61 years,11553,male, female, 14 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeters and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), 2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, Australie, Nouvelle z\u0026eacute;lande, China, Hong Kong, Japan, South Corea, Singapoure, Taiwan, Thailand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u0026ndash;75 years,996624,male, female,6 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJousilhati and al(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e),1999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, Finlande\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u0026ndash;64 years,14786,male, female,\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBostom and al(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e),1994\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u0026ndash;64 years,3103,female\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChomistek and al(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e),2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u0026ndash;44 ans,88940,women\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLv and al(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e),2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, Chine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u0026ndash;79 years,461211,female,male\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChiuve and al(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e),2006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40-75years,42847,male\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarsson and al(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e),2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, Su\u0026egrave;de\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u0026ndash;83 years,64676,male, female\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScheen and al(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) 2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase control study, Asie, Europe, Moyen Orient, Afrique, Australie, Am\u0026eacute;rique du Nord, Am\u0026eacute;rique du Sud\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale, female,15152 case,14820 control\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eO'Donnel and al(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) 2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase control study, Africa, Asia, Europe, Australie, America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMale,female,3000 case,3000 contr\u0026ocirc;le\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSwamithan and al(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), 2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProspective study, America, Africa, Middle East, South Asia, China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148858,35\u0026ndash;70 years, male, female\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSteffen and al(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e),2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProspective study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e157792,male,female,45\u0026ndash;64 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTao and al(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e),2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, UK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.57 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e407500,38\u0026ndash;73 years, male, female\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWilson and al(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e),2005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3310,male,female,moyenne 57,59 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCohen and al(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNested Case control study, UK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25663,male,female,45\u0026ndash;79 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDebras and al(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e),2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, France\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103388,male,female,\u0026ge;18 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSun and al(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), 2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, UK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107227,male,female,35\u0026ndash;73 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhang and al(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e),2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, Chine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87723,masculin, f\u0026eacute;minin,\u0026ge;18years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiu and al(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e),2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, Chine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e945,masculin,f\u0026eacute;minin,35-59years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMa Hao and al(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e),2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, UK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.8years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e176570,masculin,f\u0026eacute;minin,37\u0026ndash;73 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMa Yuan and al(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e),2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.8 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10707,masculin,f\u0026eacute;minin,51\u0026thinsp;\u0026plusmn;\u0026thinsp;12,6 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAyas and al(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e),2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohort study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71617,feminin,45\u0026ndash;65 years\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSabanayagam and al(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e),2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase control study, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31428,female,male,\u0026ge; 18 \u0026amp;ns\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e1. Metabolic factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eModifiable risk factors are factors which can be reduced or eliminated by human action. They are classified into two subgroups: metabolic factors, or factors relating to a physiopathological state, and lifestyle factors, or behavioral factors [9]. The role of metabolic risk factors has been highlighted by several scientific studies; some of them have been included in this literature review to illustrate their causality in the occurrence of cardiovascular disease. These risk factors are arterial hypertension, dyslipidemia, diabetes mellitus and overweight.\u003c/p\u003e\u003cp\u003eHypertension is defined as systolic blood pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or equal to 90 mmHg recorded at two distinct occasions and not on the same day. Dyslipidemia is a metabolic abnormality characterized by an abnormal concentration of lipids in the blood, such as total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTotal cholesterol should be less than 2.2 g/L, LDL cholesterol less than or equal to 1.6 g/L and HDL cholesterol greater than 0.4 g/L. Normal triglyceride levels are between 1.5 and 2 g/L.\u003c/p\u003e\u003cp\u003eDiabetes mellitus is a metabolic disease characterized by the presence of chronic hyperglycemia resulting either from a deficiency in insulin secretion, an abnormality in insulin action on target tissues, or a combination of both. Diabetes mellitus takes three forms: Type 1 diabetes, which is autoimmune in origin, type 2 diabetes, in which insulin resistance plays an important role, and gestational diabetes (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eObesity is a complex, chronic disease defined by excessive deposition of adipose tissue, which can be detrimental to health. Overweight and obesity are diagnosed by measuring weight and height, and calculating the body mass index (BMI): weight (kg)/height\u0026sup2; (m\u0026sup2;). According to World Health Organization criteria, an individual is said to be overweight when his or her BMI is between 25 KG/m2 and 29.9 kg/m2, and obese when his or her BMI is \u0026ge;\u0026thinsp;30 kg/m2 (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTable II illustrates the causal role of metabolic risk factors in the development of cardiovascular disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable II: Causality of metabolic cardiovascular risk factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRisk factors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eAdjusted risk ratio\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eHigh blood pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCouillard and al(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2.32(1.35\u0026ndash;3.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeter and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.38(1.25\u0026ndash;1.51)♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.38(1.28\u0026ndash;1.46)♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJousilahti and al(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.11(1.07\u0026ndash;1.16)♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.11(1.04\u0026ndash;1.18)♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWilson and al(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.15(1.09\u0026ndash;1.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohen and al(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.56(1.22\u0026ndash;1.99)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHypercholesterolemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCouillard and al(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2.15(1.34\u0026ndash;3.44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBostom and al(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2.26(1.41\u0026ndash;3.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNguyen and al(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.32(1.2\u0026ndash;1.5)♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4(1.2\u0026ndash;1.7)♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeter and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.25(1.16\u0026ndash;1.35) ♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,35(1.26\u0026ndash;1.44) ♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHypertryglyc\u0026eacute;ridemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeter and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.33(1.16\u0026ndash;1.54) ♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.24(1.16\u0026ndash;1.32) ♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNguyen and al(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.4(1.12\u0026ndash;1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHyperLDL\u0026eacute;mia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTian and al(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.06(1.02\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCouillard and al(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2.28(1.38\u0026ndash;3.75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohen and al(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.68(1.33\u0026ndash;2.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHyperHDL\u0026eacute;mia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCouillard and al(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.50(0.30\u0026ndash;0.81)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJousilahti and al(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50(0.39\u0026ndash;0.64♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.45(0.38\u0026ndash;0.54)♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohen and al(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.57(0.44\u0026ndash;0.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTian and al(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.52(1.44\u0026ndash;1.61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWilson and al(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e2(1.56\u0026ndash;2.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeter and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.04(1.58\u0026ndash;2.64)♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.56(1.32\u0026ndash;1.90)♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOverweight or obesity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeter and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.22(1.09\u0026ndash;1.37)♀\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.25(1.15\u0026ndash;1.36)♂\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohen and al(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.74(1.36\u0026ndash;2.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTian and al(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e1.25(1.21\u0026ndash;1.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTo prevent the onset of cardiovascular disease, it is essential to combat metabolic cardiovascular risk factors by reinforcing health education so that adults could adopt positive health behaviors.\u003c/p\u003e\u003cp\u003eFirstly, screening for potential health problems such as dyslipidemia, diabete mellitus, obesity and high blood pressure and once these conditions have been identified, follow medical or dietary-hygienic treatment.\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.Behavioral factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBehavioral risk factors can be modified by the individual according to the lifestyle he or she adopts. Research into etiological epidemiology has highlighted behavioral risk factors, and we present some of the scientific evidence to support the development of health-promoting lifestyles.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSmoking refers to tobacco consumption or intoxication related to tobacco use. Tian and al(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) have demonstrated the role of smoking in the onset of cardiovascular disease: adjusted RR\u0026thinsp;=\u0026thinsp;1.16 (1.13\u0026ndash;1.20); and other authors have reached similar conclusions concerning smoking, including Couillard and al(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.20(1.05\u0026ndash;1.35) ; Peter and al(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;1.61(1.39\u0026ndash;1.87) ♀ Adjusted RR\u0026thinsp;=\u0026thinsp;1.52(1.39\u0026ndash;1.68) ♂ ; Jousilahti and al(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;1.77(1.49\u0026ndash;2.11) ♀ Adjusted RR\u0026thinsp;=\u0026thinsp;2.14(1.46\u0026ndash;3.14) ♂ ; Scheen and al (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)adjusted OR\u0026thinsp;=\u0026thinsp;2.87(2.58\u0026ndash;3.19); O'Donnel and al (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)adjusted OR\u0026thinsp;=\u0026thinsp;2.09(1.75\u0026ndash;2.51).\u003c/p\u003e\u003cp\u003eNo smoking has been identified as a protective factor by Chomistek and al (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) RR adjusted\u0026thinsp;=\u0026thinsp;0.29(0.23\u0026ndash;0.35); Larsson and al (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) RR adjusted\u0026thinsp;=\u0026thinsp;0.64(0.50\u0026ndash;0.84); Chiuve and al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) RR adjusted\u0026thinsp;=\u0026thinsp;0.47(0.41\u0026ndash;0.53) ♀ RR adjusted\u0026thinsp;=\u0026thinsp;0.57(0.46\u0026ndash;0.69) ♂. The reduction of cardiovascular risk varies from 36% to 71% for non-smokers compared to smokers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiet\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHigh consumption of vegetables and fruit, wholegrain cereals, nuts, legumes, polyunsaturated fatty acids, moderate alcohol consumption combined with low consumption of sugar, sweetened beverages, red meat or processed meat was identified as a protective factor by Chomistek et al (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) RR adjusted\u0026thinsp;=\u0026thinsp;0.69(0.57\u0026ndash;0.85).\u003c/p\u003e\u003cp\u003eConsumption of polyunsaturated fatty acids to the detriment of trans fatty acids, consumption of chicken meat and fish to the detriment of red meat, high consumption of vegetables and fruit, soy products, cereal fibers, and tofu was identified as a protective factor Adjusted RR\u0026thinsp;=\u0026thinsp;0.75(0.69-0, 82) by Chiuve et al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eRegular consumption of fruit and vegetables, nuts, skimmed milk products, wholegrain cereals and fish to the detriment of red or processed meat, fried potatoes, solid fats, refined cereals, various sweet foods and full-fat cheese was isolated as a protective factor by Larsson et al (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;0.76(0.65\u0026ndash;0.90)\u003c/p\u003e\u003cp\u003eDaily consumption of fruit and vegetables and limited consumption of red meat is a protective factor highlighted by Lv et al (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;0.89(0.84-\u0026agrave;.94).\u003c/p\u003e\u003cp\u003eThe reduction of cardiovascular risk varies from 11% to 59% among people who adopt an adequate diet compared to those with non-adequate diet.\u003c/p\u003e\u003cp\u003eA diet rich in fruit and vegetables as a daily intake was identified as a protective factor by Scheen and al (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Adjusted OR\u0026thinsp;=\u0026thinsp;0.70(0. 62-0.79) and O\u0026rsquo;Donnel and al (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Adjusted OR\u0026thinsp;=\u0026thinsp;0.61(0.50-0,73).\u003c/p\u003e\u003cp\u003eConsumption of artificial sweeteners was identified as a cardiovascular risk factor by Sun and al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.012(1.008\u0026ndash;1.017) and Debras and al (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.09(1.01\u0026ndash;1.18). Sweeteners are food additives that impart a sweet taste without increasing the sugar content.\u003c/p\u003e\u003cp\u003eSwamithan and al (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) identified high consumption of refined cereals as a cardiovascular risk factor (adjusted RR\u0026thinsp;=\u0026thinsp;1.33(1.16\u0026ndash;1.52)) while Steffen and al (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) highlighted the protective role of whole-grain consumption (adjusted RR\u0026thinsp;=\u0026thinsp;0.72(0.53\u0026ndash;0.97)) and high fruit and vegetable consumption (adjusted RR\u0026thinsp;=\u0026thinsp;0.59(0.42\u0026ndash;0.81)).\u003c/p\u003e\u003cp\u003eIn summary, based on the above, the foods recommended for good cardiovascular health are listed in Table\u0026nbsp;3\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable III: List of recommended and non-recommended foods for cardiovascular prevention\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecommended food\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-recommended food\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.Vegetables\u003c/p\u003e\u003cp\u003e2.Fruit\u003c/p\u003e\u003cp\u003e3.Chicken\u003c/p\u003e\u003cp\u003e4.Fish\u003c/p\u003e\u003cp\u003e5.Nuts\u003c/p\u003e\u003cp\u003e6.Wholegrain cereals: whole meal flours, brown bread\u003c/p\u003e\u003cp\u003e7.Skimmed milk products\u003c/p\u003e\u003cp\u003e8.Polyunsaturated fatty acids: olive oil, corn oil, sunflower oil, sesame oil, peanut oil, oily fish, sardines, walnut oil, etc.\u003c/p\u003e\u003cp\u003e9.Soy products\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.Red meat\u003c/p\u003e\u003cp\u003e2.Refined cereals: white flour, white bread\u003c/p\u003e\u003cp\u003e3.Saturated fatty acids of animal origin: cold meats, butter\u003c/p\u003e\u003cp\u003e4.Trans fatty acids: fried foods, bakery products, cookies, pie, dairy products\u003c/p\u003e\u003cp\u003e5.Sugary drinks\u003c/p\u003e\u003cp\u003e6.Sweeteners: soft drinks, canderel\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSalt consumption\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHigh excretion of sodium in urine was identified as a cardiovascular risk factor by Liu and al (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;3.04(1.46\u0026ndash;6.34) and by Ma Yuan and al (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.18(1.08\u0026ndash;1.29). The permanent addition of table salt was isolated as a cardiovascular risk factor by Ma Hao and al (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;0.77(0.70\u0026ndash;0.84). The reduction of cardiovascular risk can be estimated to 23% among people who reduce salt consumption.\u003c/p\u003e\u003cp\u003eTo reduce salt consumption, good habits are suggested: consume home-cooked meals, eat mainly fresh and minimally processed foods, choose low-sodium products (less than 120 mg/100 g sodium), cook adding little salt, use herbs or spices to flavor foods, rather than salt, limit the use of salad dressings, remove the salt shaker from the table (32).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConsumption of alcohol\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable IV: Quantity, frequency of alcohol consumption and associated cardiovascular risk\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantity of alcohol consumed\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eajusted RR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChomistek and al(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eO.1-14.9g/day i.e. one glass\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.77(0.64\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChiuve and al(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;30 g/day i.e moderate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.77(0.70\u0026ndash;0.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLv and al(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30 g/day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90(0.82\u0026ndash;0.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhangh and al(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHeavy consumption\u0026thinsp;\u0026gt;\u0026thinsp;150 g/week versus light to moderate consumption\u0026thinsp;\u0026lt;\u0026thinsp;150g per week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.41(1.08\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eO\u0026rsquo;Donnel and al(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 glasses per month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.51(1.18\u0026ndash;1.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe reduction of cardiovascular risk varies from 10% to 23% among people who drink a moderate quantity of alcohol compared to heavy drunker. Light to moderate alcohol consumption should be encouraged to prevent cardiovascular disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePhysical activity\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable V: Frequency and duration of physical activity and associated cardiovascular risk\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency and duration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChomistek and al(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.5 hours a week of moderate to intense physical activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.72(0.58\u0026ndash;0.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChiuve and al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 minutes a day of moderate or intense physical activity or more than or equal to 3.5 hours a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.72(0.65\u0026ndash;0.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLv and al(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian of recommended levels\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90(0.87\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eScheen and al(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAt least 4 hours a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.86(0.76\u0026ndash;0.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe reduction of cardiovascular risk varies from 10% to 28% among adult who practice moderate to intense physical activity. Regular moderate to intense physical activity lasting at least 2.5 to 4 hours a week is recommended to prevent cardiovascular disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSleep\u003c/b\u003e\u003c/p\u003e\u003cp\u003eQuality sleep (without insomnia or narcolepsy) and optimal sleep duration (7 hours a day) have been identified as protective factors against the onset of cardiovascular disease.\u003c/p\u003e\u003cp\u003eThus, individuals with disturbed sleep have a higher risk of cardiovascular disease than individuals with healthy sleep (Tian and al (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.06(1.02\u0026ndash;1.09) ;( Tao and al (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.26(1.21\u0026ndash;1.32).\u003c/p\u003e\u003cp\u003eIndividuals with a sleep duration greater than or equal to 9 hours per day or less than or equal to 5 hours per day have a great risk of developing cardiovascular disease than those who sleep 7 hours a day (Tao and al (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;1.23(1.16\u0026ndash;1.31)) ; (Ayas and al (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;1.82(1.34 ;2.41), Adjusted RR\u0026thinsp;=\u0026thinsp;1.57(1.18 ;2.11)); (Sabayagam and al (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) Adjusted RR\u0026thinsp;=\u0026thinsp;2.20(1.73 ;2.71) Adjusted RR\u0026thinsp;=\u0026thinsp;1.57(1.31 ;1.89)).\u003c/p\u003e\u003cp\u003eGood sleep habits, such as going to bed and getting up at a fixed time, and sleeping 7 hours a day, are among the factors contributing to good cardiovascular health.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMental health\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDepression has been identified as a cardiovascular risk factor by Tian and al (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;1.35(1.25\u0026ndash;1.45), Scheen and al (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) adjusted OR\u0026thinsp;=\u0026thinsp;1.55(1.42\u0026ndash;1.69); O'Donnell and al (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) adjusted OR\u0026thinsp;=\u0026thinsp;1.35(1.10\u0026ndash;1.66).\u003c/p\u003e\u003cp\u003ePsychosocial stress has also been identified as a cardiovascular risk factor by Scheen and al (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) adjusted OR\u0026thinsp;=\u0026thinsp;2.67(2.21\u0026ndash;3.22) and O'Donnell and al (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) adjusted OR\u0026thinsp;=\u0026thinsp;1.30(1.06\u0026ndash;1.60). Maintaining and restoring mental health contributes to good cardiovascular health\u003c/p\u003e\u003cp\u003e\u003cb\u003eCombination of several behavioral factors\u003c/b\u003e\u003c/p\u003e\u003cp\u003eChomistek and al (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) (adjusted RR\u0026thinsp;=\u0026thinsp;0.08(0.03\u0026ndash;0.22), Chiuve and al (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) (adjusted RR\u0026thinsp;=\u0026thinsp;0.37(0.26\u0026ndash;0.53), Lv and al (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) (adjusted RR\u0026thinsp;=\u0026thinsp;0.37(0.16\u0026ndash;0.84), Larsson and al (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) adjusted RR\u0026thinsp;=\u0026thinsp;0, 14(0.04\u0026ndash;0.43) have demonstrated through their cohort studies that several good health habits in the same individual increase their protective effects against the onset of cardiovascular disease. The reduction of cardiovascular risk varies from 70% to 90%. Thus, an individual should at best practice several health habits to maintain his or her cardiovascular health.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable VI: Behavioral risk factors and their combined effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1760442994.png\" style=\"width: 634px;\"\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable VII: Summary of health-promoting habits to prevent cardiovascular disease in adult men and women\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eScreening for diabetes, high blood pressure, dyslipidemia or obesity\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFollow treatment for diabetes, high blood pressure, dyslipidemia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAvoid smoking or give up smoking\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrefer recommended foods or at best avoid non-recommended foods\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReduce salt intake, avoid adding salt in meals\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReduce alcohol consumption at one glass a day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractice regular physical activity for at least 2.5 hours a week\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSleep and get up at set times, get at least 7 hours of sleep\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMake time for relaxation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTry to combine as many of the above behaviors as possible to improve cardiovascular health.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"IV. Discussion","content":"\u003cp\u003eThe aim of this literature review was to identify good health habits that can be adopted to prevent the onset of cardiovascular disease, whether deducted from metabolic factors or lifestyle factors. A selection of articles relevant to the subject was made to include 25 analytical studies, 21 of them were conducted according to the prospective cohort design. Only 3 studies were extended to the African continent.\u003c/p\u003e\u003cp\u003eScreening or controlling metabolic risk factors is one of the health habits to be adopted to prevent the onset of cardiovascular disease. Adults should undergo regular health checkups to detect any metabolic risk factors. Other authors such as Andr\u0026eacute;adis et al (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and Jeppesen et al (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) have identified metabolic syndrome as a factor increasing cardiovascular risk. The metabolic syndrome is defined by an accumulation of abdominal fat in addition to two of the following abnormalities: hyperglycemia, hypertriglyceridemia, hypoHDLemia and arterial hypertension.\u003c/p\u003e\u003cp\u003eLifestyle-related cardiovascular risk factors are also a prime target for cardiovascular prevention. Although some studies show benefits of moderate alcohol, recent research warns about cancer risk (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). So, avoiding alcohol may be safest overall. Lifestyle factors, when combined, have a powerful synergistic effect. This idea is supported by other authors, notably Zhang et al (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) in their systematic review and meta-analysis of prospective cohorts.\u003c/p\u003e\u003cp\u003eThe adoption of identified health behaviors faces economic constraints. Indeed, non-communicable diseases such as hypertension, diabetes mellitus and dyslipidemia require treatment and prolonged follow-up, which are not financially accessible to a large number of individuals in low-income countries.\u003c/p\u003e\u003cp\u003eSimilarly, daily access to fruit and vegetables in addition to calorie-dense foods, and access to chicken or fish meat, is not automatic due to financial constraints. On the other hand, certain behaviors are accessible, such as avoiding tobacco and alcohol, regular physical activity, quality sleep, reduced salt consumption, and consumption of polyunsaturated fatty acids rather than saturated oils.\u003c/p\u003e\u003cp\u003eAlthough this systematic review identified healthy behaviors that adults should adopt to reduce cardiovascular risk, the study faced limitations such as the scarcity of prospective studies in Africa hence the inclusion of case-control studies even though they have a low level of scientific evidence compared to prospective studies. As perspectives, prospective studies should be encouraged in Africa\u003c/p\u003e"},{"header":"VI. Conclusion","content":"\u003cp\u003eIn conclusion, the health behaviors to prevent cardiovascular risk should be encouraged to adults, whether during health education sessions or community awareness campaigns. Regarding alcohol consumption, rather than light to moderate consumption, abstinence from alcohol is the best way to prevent non-communicable diseases in general.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthor N M provided the idea of working on health behaviors to reduce cardiovascular risk, wrote the text and tables. L B S provided the overall idea of doing a systematic review on cardiovascular risk factors, the idea of illustrating cardiovascular risk reduction and improvements to the presentation of the text. N T provided guidance to better present the ideas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e \u0026ldquo;Not applicable\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganisation mondiale de la sant\u0026eacute; (2023) Maladies cardiovasculaires, principaux faits. 17 Mai \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/fr/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)#:\u003c/span\u003e\u003cspan address=\"https://www.who.int/fr/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)#:\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e~:text=Les%20maladies%20cardio%2Dvasculaires%20sont,de%20la%20mortalit%C3%A9%20mondiale%20totale.Consult\u0026eacute; le 23 Mars 2024 \u0026agrave; 11H\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrganisation mondiale de la sant\u0026eacute; (2021) \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/fr/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds\u003c/span\u003e\u003cspan address=\"https://www.who.int/fr/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). 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J Epidemiol Commun Health 75(1):92\u0026ndash;99. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/jech-2020-214050\u003c/span\u003e\u003cspan address=\"10.1136/jech-2020-214050\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health behaviors,to prevent, cardiovascular risq, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-7846964/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7846964/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA low level of health literacy contributes to the increasing prevalence of cardiovascular diseases in Africa. In addition, the management of cardiovascular diseases is hampered by poor access to quality healthcare hence the importance of primary prevention.\u003c/p\u003e\n\u003cp\u003eThe aim of this literature review was to identify good health behaviors to be adopted by individuals to prevent the onset of cardiovascular disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 25 review articles were selected from Google scholar, Science Direct, PubMed and American heart association journals. The screening and an effective treatment of dyslipidemia, hypertension, diabetes mellitus and obesity are essential means of preventing cardiovascular diseases. The lifestyle behaviors identified and their associated reduction of cardiovascular risk are respectively, not smoking (36 to 71%); a healthy diet (11 to 59%) consisting of regular consumption of fruit and vegetables, wholegrain cereals, polyunsaturated fatty acids and nuts, and chicken or fish rather than red meat; reducing alcohol consumption to one glass a day (10 to 23%) ,regular moderate to intense physical activity lasting at least 2.5 hours a week( 10 to 28%), reducing of salt consumption (23%) while sleep duration of ≤5heures and ≥9 hours can double cardiovascular risk . When combined, these behavioral protective factors potentiate each other and cardiovascular risk reduction can reach 70-90%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe adoption of health-care behaviors (screening, early treatment) and a healthy lifestyle (diet, physical activity) reduces the risk of cardiovascular disease.\u003c/p\u003e","manuscriptTitle":"Health Bihaviors to Prevent Cardiovascular Risk: A Systematic Review of the Literature","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-14 12:03:38","doi":"10.21203/rs.3.rs-7846964/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e3d80100-dd56-4ef6-adb3-d32ecc4aff03","owner":[],"postedDate":"October 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56273187,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-10-14T12:03:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-14 12:03:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7846964","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7846964","identity":"rs-7846964","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}